Key Points
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Previous studies have shown that educational outreach visits (academic detailing) can reduce inappropriate prescribing by medical practitioners.
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This study sought to assess whether academic detailing combined with printed educational material could be used to reduce antibiotic prescribing by dentists for acute dental pain.
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Evidence based guidelines for the use of antibiotics and analgesics for acute dental pain were produced.
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Antibiotic prescribing by general dental practitioners for acute dental pain can be reduced using academic detailing combined with guidelines. Guidelines alone do not affect antibiotic prescribing.
Abstract
Objective To assess the effect of educational outreach visits on antibiotic prescribing for acute dental pain in primary care.
Study design Randomised controlled trial (RCT).
Setting General dental practices in four health authority areas in Wales.
Subjects and methods General dental practitioners were recruited to the study and randomly allocated to one of the three study groups (control group, guideline group or intervention group). Following the intervention, practitioners completed a standardised questionnaire for each patient that presented with acute dental pain.
Interventions The control group received no intervention. The guideline group received educational material by post. The intervention group received educational material by post and an academic detailing visit by a trained pharmacist. The educational material included evidence-based guidelines on prescribing for acute dental pain and patient information leaflets.
Main outcome measures The number of antibiotic prescriptions issued to patients presenting with dental pain and the number of 'inappropriate' antibiotic prescriptions. Antibiotics were considered to be inappropriate if the patient did not have symptoms indicative of spreading infection.
Results A total of 1,497 completed questionnaires were received from 23, 20 and 27 general dental practitioners in the control, guideline and intervention group respectively. Patients in the intervention group received significantly fewer antibiotic prescriptions than patients in the control group (OR (95% CI) 0.63 (0.41, 0.95)) and significantly fewer inappropriate antibiotic prescriptions (OR (95% CI) 0.33 (0.21, 0.54)). However, antibiotic and inappropriate antibiotic prescribing were not significantly different in the guideline group compared to the control group (OR (95% CI) 0.83 (0.55, 1.21) and OR (95% CI) 0.82 (0.53, 1.29) respectively).
Conclusions Strategies based upon educational outreach visits may be successfully employed to rationalise antibiotic prescribing by dental practitioners.
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Acknowledgements
This study was funded in full by a grant from the NHS National R&D Programme on Primary Dental Care.
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Seager, J., Howell-Jones, R., Dunstan, F. et al. A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting. Br Dent J 201, 217–222 (2006). https://doi.org/10.1038/sj.bdj.4813879
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DOI: https://doi.org/10.1038/sj.bdj.4813879
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